KALP KAPAK HASTALIĞI OLAN GEBEDE ANESTEZİ YÖNETİMİ

Yıl 2018, Cilt: 19 Sayı: 2, 76 - 78, 26.04.2018

Erdinç Koca Hasan Şayan

https://doi.org/10.18229/kocatepetip.419057

Öz

Gebelikle birlikte kan hacmi, kalp debisi, kalp hızı artarken sistemik vasküler direnç azalır. Hemodilüsyon ve fizyolojik anemi görülür. Bu değişiklikler sağlıklı kadınlar tarafından tolere edilebilirken kalp hastalığı olan gebelerde kalp üzerinde ayrı bir yük oluşturmaktadır. Bunun sonucunda peripartum morbidite ve mortalite artmaktadır. Bu hastaların anestezi seçimi kalp hastalığının tipi, kullanılan ilaçlar, cerrahinin aciliyetine göre değişmektedir. 32 yaşında olan hastamızın 4 gebelik, 2 doğum ve 2 abortusu mevcuttu. Hastamıza 39 haftalık gebeliği ne-deniyle sezeryan planlanmıştı. Preoperatif mu-ayenesinde 5 yıl önce perkütan mitral balon valvüloplasti geçirdiği öğrenildi. Ekokardiyog-rafide mitral kapak alanı 1 cm2 olduğu, 30 aort yetmezliği ve pulmoner arter basıncı 35 mm Hg olarak tespit edildi. Hastaya lomber 4-5 verteb-ra aralığından oturur pozisyonda kombine spi-nal–epidural anestezi yapıldı. Epidural katater yoluyla perioperatif ve postoperatif anestezi ve analjezi sağlandı. Sonuç olarak kalp hastalığı olan gebelerde sezaryen uygulamasında düşük doz kombine spinal-epidural anestezi ile hemo-dinaminin daha stabil olacağını ve epidural ka-tater yoluyla da postoperatif analjezi sağlanarak taşikardi, hipertansiyon, ajitasyon gibi olumsuz etkilerin önleneceğini düşünüyoruz.

Anahtar Kelimeler

Gebe, anestezi, kalp kapak hastalığı

ANESTHETIC MANAGEMENT OF PREGNANT PATIENT WITH VALVULAR HEART DISEASE

Öz

During pregnancy, while the blood volume, cardiac output, heart rate increase, the systemic vascular resistance decreases. Hemodilution and physiological anemia can be seen.These changes can be tolerated by pregnant healthy women but they can be an overload on the heart with pregnant women who have cardiac diseases. For this reason the peripartum morbidity and mortality increase. The selection of anesthesia in these patients varies according to the type of cardiac disease, drugs used,and to the urgency of the surgery. Our case was a 32 year-old who had four gravity, two parity and two abortions. Caesarean section was planned for the patient at 39 weeks of gestation In the preoperative examination we learned that she had underwent a percutaneous mitral balloon valvuloplasty five years ago. In echocardiography the mitral valve area was 1 square centimeter, 30 aortic insufficiency was detected and pulmonary artery pressure was 35 mm Hg. The spinal-epidural anesthesia was performed through the L4-L5 intervertebral space with the patient in the sitting position. Perioperative anesthesia and analgesia was provided by epidural catheter. As a result we believe that the low-dose combined spinal-epidural anaesthesia will be more stable on the hemodynamics in the implementation of cesarean section in pregnant women with heart disease and we believe that providing postoperative analgesia via an epidural catheter may prevent the adverse effects such as tachycardia, hypertension and agitation.

Anahtar Kelimeler

Pregnancy, anesthesia, valvular heart disease

Kaynakça

• Hidano G, Uezono S, Terui K. A retrospective survey ofadverse maternal and neonatal outcomes for parturients with congenital heart disease. Int J Obs Anesthesia 2011; 20: 229-35.
• Hamlyn EL, Douglass CA, Plaat F, Crowhurst JA, Stocks GM.Low-dose sequential combined spinal-epidural: an anaesthetic technique for caesarean section in patients with significant cardiac disease. Int J Obstet Anesth 2005; 14(4): 355-61.
• Yeomans ER, Gilstrap LC III. Physiologic changes in pregnancy and their impact on critical care. Crit Care Med 2005; 33(10): 256-8.
• Robson SC, Hunter S, Boys RJ, Dunlop W. Serial study offactors influencing changes in cardiac output during human pregnancy. Am J Physiol 1989; 256(2): 1060-5.
• Bhatla N, Lal S, Behera G, Kriplani A, Mittal S, Agarwal N, et al. Cardiac disease in pregnancy. Int J Gynaecol Obstet 2003;82(2): 153-9.
• Goldszmidt E, Macarthur A, Silversides C, Colman J, SermerM, Siu S. Anesthetic management of a consecutive cohort of women with heart disease for labor and delivery. Int J Obstet Anesth 2010; 19: 15-42.
• Riberio P, Al Zaibag M: Rheumatic heart disease. In OakleyC (ed). Heart disease in pregnancy. London, BMJ Publis hing Group, 1997: 112-27.
• Shabetai R: Cardiac Diseases. In Creasy RK, Resnik R (eds).Maternal - fetal Medicine 4th ed. London, WB Saunders Comp. 1999: 793-819.
• Akpınar O. Pregnancy and heart valve disease. AnadoluKardiyol Derg 2009; 9(1): 25-34.
• Filiz Tuzuner Anestezi Yoğun Bakım Ağrı. Nobel Tıp Kitabevi, İstanbul: 2010: 306-7.
• Boyle RK. Anaesthesia in parturients with heart disease: afive year review in an Australian tertiary hospital. Int J ObstetAnesth 2003; 12(3): 173-7.
• Ioscovich A, Briskin A, Fadeev A, Grisaru-Granovsky S,Halpern S. Emergency cesarean section in a patient with Fontancirculation using an indwelling epidural catheter. J Clin Anesth 2006; 18: 51-4.
• Yıldırım Öİ, Günüşen İ, Sargın A, Fırat V, Karaman S. KalpHastalığı Olan Gebelerde Sezaryende Uygulanan Anestezi Yöntemlerinin Retrospektif Değerlendirilmesi. Turk J Anaesth Reanim 2014; 42: 326-31.